Prolonged Exposure for PTSD
Edna Foa & Rikke Kjelgaard
Prolonged Exposure for PTSD
Prolonged Exposure for PTSD
The Perfectionistic Therapist
Q & A session
ACTing in life’s scariest moments
The Tif’eret of Illness and Pain
Craving Life: ACT for Addictions and Cravings
by Rikke Kjelgaard
“Are you seriously asking my to accept this sh*t? Really? Ehhh… Thank you, but no thank you!”.
“I am in pain! Why are you talking about acceptance? I don’t WANT TO accept. Can’t you just make it go away?”.
“Should I just give up then???”.
I get it. I really do.
For most people acceptance sounds like “liking”, “tolerating”, “wanting” or even “wishing for” something. And as a therapist working with acceptance as one of my main tools, I am often faced with resistance whenever I mention acceptance.
And that is because the kind of acceptance that I am referring to is often being misunderstood as it means something completely different for the person I am talking to.
An example of a difficult situation I got myself into was with a mother who tragically lost 3 of her children.
I was kind of new as a therapist and I was totally in love with the concept of acceptance.
So I would talk about acceptance as the solution to Every. Problem. In. The. Universe (ish).
My client – the mother who lost her children – was of course drowning in grief. And my invitation was to find a way to carry that grief so that she could live a valued life, be the mother she wanted to be for the child that she didn’t loose and be the partner she wanted to be towards her partner. With grief.
Sounds good, right?
The problem is that I used the word acceptance.
And because I used that word, what she heard me say was: “why can’t you just accept that you’ve lost 3 children?”.
(I can barely write this).
*face turns read from shame*
You hear how that sounds, right?
And so I had to spend several sessions trying to repair the damage that was done.
My intention was kind and friendly.
I never said what she heard.
And. It. Doesn’t. Matter.
It broke her heart.
(And mine was broken too by that).
So despite the shame of telling you about my mistakes, I’d like to share what I have learned (sometimes the hard way) about what acceptance is and what it isn’t.
Who on earth wants to experience the heartbreak of loss?
Who on earth likes to have anxiety?
Who on earth wishes to go through grief?
Who on earth chooses depression?
Would it be fair to say that most people don’t?
But what I am asking you to do, is to hold space for what it is you are experiencing inside of you.
You might have been in situations that were really, really horrible. And you might then now be feeling really, really horrible.
And while it’s not okay that bad things happen to anyone, it IS okay to feel what ever it is that we feel.
See, the more we try not to feel something the bigger it tends to get.
And life then becomes about not feeling or not having certain thoughts or not experiencing inner experiences.
Acceptance – then – is all about being willing to experience your inner universe as it is in order to pursue the life you want to live and do the things that matter to you.
Many of my clients come to me asking to feel acceptance.
Like, “If you could just teach me how to feel acceptance, then this [unwanted inner experience] will go away, right?”.
Sorry, precious. It doesn’t work like that.
Acceptance is not a passive proces. It’s not a feeling that you will find inside of you. It’s not a destination that you arrive at.
Acceptance is a verb. It’s a continuous practice. It’s an active choice you have in every moment to be with and make room for what is.
And frustrating as that might be, it’s like a muscle that you can tone. A muscle that get’s stronger.
Most of us are finding ourselves dancing back and forth from acceptance to resistance. That is normal. And that is okay. And that dance too is something that we can hold space for.
Acceptance is all about making room for your inner psychological universe in the service of connecting with and pursuing what matters to you.
It is NOT about accepting that your boss acts like an asshole or that your partner hits you when they’re drunk.
There are many situations in life that are completely unacceptable and where you should change something.
(I could talk about setting boundaries and taking sh*t from no one forever, but that shall be another post!).
If you can change something and that change is based on what you value in life, then you should go for it.
But if you’re trying to control your inner environment at the cost of keeping you from living well, then you might want to let go of your control efforts and practice willingness to sit with discomfort instead.
(It might suck a
little lot. I know.)
Can you be with that too, precious?
by Rikke Kjelgaard
In my life I’ve had my fair share of both sh*t and sunshine.
My parents did and continue to do the best they can for both me and my brother. They’re obviously from a whole different generation and their way of approaching many things are way different than mine. Both because times have changed and because I do what I do for a living. Having vulnerable conversations was never our greatest family superpower. Neither was having strong emotions. Truth be told: no one taught my parents how to handle or talk about all the messy psychological sh*t we humans encounter through life and so they did their best to control their inner and outer environment. Now as I am
all fairly grown up I see things from a different perspective and I have nothing but respect, admiration and compassion for my parents. They truly did the best they could.
Still. They taught me stuff I wish I never learned.
In 2018 me and my mum went to Nepal together. She was 71 at the time. Talk about being a badass!! The days were spent
walking climbing up and down mountains and our psychological and physical limits were being tested in so many ways. As we stood in front of what we referred to as “a wall” that we were supposed to climb, my mother just lost it. She could not see herself climbing up that hill. She cried. She was afraid. She was not the superwoman mother that I normally get to see. It was very difficult for me to witness. The local sherpa guides instantly came and offered to carry her bag. And then it happened. I heard my mom say stuff like:
“It’s my own fault. I chose to come here myself”.
“I packed my own bag. It’s my responsibility. I should have packed lighter”.
“I don’t want to be a burden”.
And then I realised: this lady never asks for help. Like: never. I know she has her reasons. When she lost both her parents she actually went to see a therapist. At their first – and only – session she told about her loss and the therapist started sobbing and the secretary waltzed in to comfort him. The therapist. My mum was left to witness this entire circus and cleverly left the sobbing scene. Not only was my mom brought up at at time where you did not ask for help but she was also being heavily punished for actually doing so, when she really, really needed it.
What has that got to do with me, then?
Well. I am sure if you asked my mother if she would want me to ask for – and get – help, her answer would be a big fat yes. So she has never actually told me to not ask for help. But throughout life she has modelled that you mind your own business and that you don’t show weakness.
Back to Nepal.
There she was. Crying. Shaking. And trying to convince the sherpa guides that she didn’t really need (ie: deserve) to be helped.
Their response was something in the line of: “if YOU don’t get up, then WE don’t get up”.
In their culture asking for help and helping others is just the most natural thing. For “us” Westerners – it just isn’t.
It had a profound impact on me to watch her hand over her bag to the guides and let herself be held and helped up that wall. Can you imagine being 71 years old before you show yourself weak and ask for help?
My mum is such a badass. She truly is. But dammit how I will not walk that path myself.
I am inviting you, me, my kids, my family, my friends, my clients and the whole damn universe to start asking for help and show up vulnerable.
You might not be carried every time you ask.
But if you don’t ask to be carried then surely it won’t happen.
And you deserve to get help when you need it.
Because if YOU don’t get up then WE don’t get up.
And we’re all in this together.
And you are not alone.
Want to go to Nepal yourself?
I highly recommend Dr. Louise Hayes and Mingma Chhirings “Mindful Adventures”.
All proceeds helps educate children in remote Nepal.
by Rikke Kjelgaard
For sure. You are there to help your client. You are there to do therapy. You have the best intentions. No doubt about that. And still sometimes you get caught in your own inner world of discomfort, right?
I know I do.
I work with this thing called ACT (Acceptance and Commitment Therapy). It’s a model that includes openness to your inner universe of thoughts, feelings and sensations. Awareness of the here and now as well as the workability of your behaviour. And engagement in whatever it is that makes your heart sing. This probably should mean that I kind of “have my sh*t together”, right? Because, well, basically I would know how to live a vital and meaning full life with whatever experience your mind throws at you.
So here’s the thing. (And I know that you know this. Just consider this a friendly reminder, my dear). Just because you KNOW stuff doesn’t mean that you actually DO stuff.
So allow me to invite you to some of the darkest corners of my shameful moments as an ACT therapist. My hands are literally shaking as I type this and discomfort in all it’s various colours and shapes are breathing down my neck. You will soon see why.
Some time ago a suicidal client came to see me. She was obviously not feeling well. She felt so lost in this world that she had actually written a suicide note for her kids. Can you imagine this? Feeling so bad that you are convinced that you would do the world in general and your kids in particular a great favour by taking your own life? And then imagine actually having the guts to share this with your therapist. That, my dear, is bravery! And so she read the letter out loud to me. Her hands were shaking and tears came down her cheeks. She looked so little and so fragile and ever so helpless.
My mind was playing louder than a heavy metal concert of “horrible thoughts and worst disasters ever” and my entire register of uncomfortable feelings was dancing inside of my skin. I felt lost. I felt scared. I felt incompetent. I felt insecure. I felt unbelievably sad. And I did not know what to do or what to say. So I did what I do best. I talked. And talked. And then talked some more. I got up to the whiteboard and started drawing charts and boxes and gave her a little lecture on “something that sounded smart”. And then I told her about ACT. (Note that I did not actually DO anything that remotely looks like ACT. But I did talk about it!). So I told her about acceptance. I told her about stepping back from thoughts. I told her to be here and now. I told her to see herself as the larger context and not as her stories. I told her to set a direction and engage her behaviours in that direction. Oh yes. I gave her The Talk. And halfway through that I actually noticed myself doing just that. But I felt completely unable to stop myself. So not only did I give her The Talk – I simultaneously pulled out my big metaphorical hammer and banged myself in my head for being the worst therapist ever. And even the worst person ever. And so it went on for the entire session. I was talking. Quietly bullying myself. And she just sat there and witnessed it all. So little. So fragile. So lost.
By great fortune she chose to come back to me at the following session. Later, when I asked her why she would even consider coming back she told me, that “I was her only hope”. Really? That was the best she could get? Oh, the shame. And oh, the heartbreak. Cause you know why? Because THAT person – the chatty lecturer that starts to dance whenever my inner demons tells me to is truly NOT who I want to be. I want to be of service to folks. I want to be kind. Towards other and towards myself. I want to be brave. I want to empower people. I want to make a difference in this world, and I truly believe that ACT is a method that can DO that for folks. But not if you just talk about it. See, while I was giving her The Talk I was at the same time modelling the complete opposite of ACT. I was telling her about acceptance whilst trying to control e-v-e-r-y-t-h-i-n-g. I was preaching mindfulness while being soooooo full of mind. I was asking her to set direction and put her feet down in that direction while taking the road to hell myself.
And this is where I chose to do something different. And (in my own humble opinion)
a little brave. I stepped outside of my comfort zone and connected with my own vulnerability and shame. Not because I felt sorry for myself. But because I wanted to walk the talk. I wanted to show her ACT. I wanted to sit with her inside of the darkness with kindness and compassion. She was not alone. Nor was I.
And so I apologised. I truly, truly apologised. Not for feeling lost and scared but for showing her the opposite of what I asked her to do. And I silently gave myself an apology for beating myself up too. I promised her that I would not be able to take away her darkness but that I would always choose to sit with her in that. I promised her to respond with awareness and to hold both of us with compassion. And I cried. Tears of shame and sadness. And she did too.
See, this was not in the service of getting myself off the hook. No, not at all. This was in the service of me being the therapist that I truly want to be AND – most importantly of all – in the service of being the vicacious hope that she needed. Showing her that she was not alone. Showing her that she matters. Letting her know that this CAN be done and that I have hope for her. Letting her see herself through my kind, loving and compassionate eyes. And THAT made a difference. It totally changed the path of the sessions we had together. And – for me personally and professionally – it stands out as one of the most shameful and yet most important learning lessons that I have had in my career.
My intention is to let you know that you are not alone. You might not have had this particular struggle when doing therapy, but my guess would be that you do know struggle. In your life in general and at work too. And you might feel shameful or regret the choices that you’ve made. My invitation is that you ask yourself what lessons you could take away from whatever experiences you have had of being stuck? For me, it was a profound experience of finding values inside of a deeply painful event. And might you offer yourself some kindness and compassion for being human? Maybe you felt compassion towards me for sharing this shameful story. What would it look like if you gave yourself the very same gift that you so easily would give to me?
Don’t just think about it. Practice actually doing it. You are not alone and I will willingly sit with you in your darkness as you just sat with me in mine.
You’ve got this, fellow traveler.
And you are not alone.
Learning the Hard Way: Resisting and Fighting All the Way to Acceptance
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